Human milk sharing, including wet nursing, donation, and sale, has existed for centuries to nourish infants whose mothers cannot provide milk. Modern technology has digitized this exchange, creating a complex market for peer-to-peer transactions. This shift prompts questions about the economic, legal, and safety implications of selling a biological fluid. Understanding the modern landscape requires clarity on its regulatory status and exchange channels.
The Legal Landscape of Compensated Sharing
The direct sale of human breast milk in the United States exists in a regulatory gray area. Federal agencies do not strictly police individual transactions. The Food and Drug Administration (FDA) has not classified human milk as a commercial food product, meaning it does not regulate sales like dairy milk or infant formula. Instead, the FDA issues public health warnings about the risks of informally shared or purchased milk due to the lack of donor screening and processing standards.
Federal laws, such as the National Organ Transplant Act (NOTA), prohibit the sale of most human organs and non-regenerative tissues. However, these laws typically exclude replenishable bodily fluids, such as blood, plasma, and human milk, from the prohibition on commercial sale. State laws vary, but most do not explicitly criminalize the informal sale of milk.
A distinction exists between outright commercial sale and compensated donation. Non-profit milk banks treat milk as a donation, structuring any payment as reimbursement for expenses related to screening, collection, and storage, not a price per ounce. Conversely, direct online sales are pure commercial transactions where the mother is paid for the volume of the milk itself. This commercial exchange, while unregulated and discouraged by health organizations, is generally not illegal under current statutes.
Regulated Milk Banks Versus Direct Online Sales
The human milk marketplace is divided into highly regulated non-profit milk banks and the entirely unregulated peer-to-peer online market. Milk banks accredited by the Human Milk Banking Association of North America (HMBANA) operate under stringent safety and ethical guidelines. Donors must undergo a comprehensive screening process, including a detailed medical history review and serological testing, before milk is accepted.
Accepted milk is pooled and subjected to Holder pasteurization, a standardized heat-treatment process designed to neutralize bacteria and viruses. The pasteurized milk is then tested for bacterial contamination before being dispensed. It is typically provided to hospitals for use with medically fragile infants, such as premature babies, often requiring a prescription. This process prioritizes safety and equitable distribution to infants with the greatest medical need, with donors providing milk altruistically without compensation for the product itself.
The direct online market, facilitated through social media and dedicated websites, lacks safety protocols. Sellers and buyers arrange transactions without third-party verification of the donor’s health or the milk’s quality. Pricing and logistics are determined individually, leading to wide variability in storage, transport, and handling practices. This unregulated environment poses significant contamination risks, as buyers have no guarantee that the milk has not been adulterated or improperly stored.
Donor Screening and Safety Requirements
Safety requirements for human milk sharing are extensive, reflecting the biological nature of the product and the vulnerability of recipients. In regulated milk banking, the process begins with mandatory serological testing of the donor mother’s blood. This testing screens for transmissible diseases.
Serological Screening
- Human Immunodeficiency Virus (HIV-1 and HIV-2)
- Human T-lymphotropic Virus (HTLV-I and HTLV-II)
- Hepatitis B and C
- Syphilis
The primary risk in unregulated, peer-to-peer milk is contamination from improper handling or undisclosed substances. Studies on milk purchased online have found high rates of bacterial contamination. This contamination can result from inadequate sanitation during pumping or storage, or sometimes from the introduction of cow’s milk or water to increase volume. Furthermore, the milk may contain prescription medications, illegal drugs, alcohol, or nicotine if the donor was not properly screened.
Pasteurization is the most important safety measure in the regulated environment. It involves heating the milk to a specific temperature, such as 62.5°C for 30 minutes, to kill harmful bacteria and viruses. After this heat treatment, the milk is cultured to ensure sterility before distribution. Without rigorous donor screening and pasteurization, the health risks associated with consuming human milk from an unknown source remain substantial.
Ethical Issues and the Commodification Debate
The sale of breast milk raises significant ethical questions centered on the commodification of a biological product, beyond legal and safety concerns. Critics argue that attaching a price to human milk risks exploiting vulnerable mothers, particularly those in economic hardship who may feel compelled to sell milk to meet financial needs. This pressure could lead mothers to prioritize milk production for sale over their own infant’s nutritional needs.
The commercialization of human milk also introduces issues of equity and access. When milk is sold for profit, the ability to purchase it becomes stratified by wealth. This potentially directs a limited, medically valuable resource away from low-income families or sick infants in hospitals. Furthermore, for-profit entities often rely on a model of compensated donation, which blurs the lines between an altruistic gift and a commercial transaction.
Ethical standards advocate for a model of voluntary donation focused on the medical needs of the recipient, typically the most fragile infants. Another element is the concern regarding informed consent. Donors must be fully aware of how their milk will be used, especially when it might be processed into non-infant products or used for adult consumption. The debate ultimately balances a mother’s autonomy and right to compensation against the moral implications of commercializing a body fluid intended for infant nutrition.